Cedars-Sinai Blog

Redesigning the OB-GYN Visit

Cold instruments, crinkly paper, scooching to the edge of the table, awkward stirrups. There's nothing about a trip to the gynecologist's office that women look forward to.

Pelvic exams may be unpleasant, but they're also an important health checkup, especially for detecting early signs of cervical cancer.

The good news is women and doctors are looking at how to improve this necessary checkup.

Building a better speculum

Arguably, the worst part of a pelvic exam is the speculum, the duck-billed instrument used to open the vagina. Its design has changed little in 170 years. The chilly metal and horrible clicking noises are among its most-hated features.

Now a team of women designers and engineers, inspired by their own anxiety-inducing trips for a cervical checkup, is working to redesign the instrument with women's comfort in mind. They're calling their project Yona. The name comes from the term "yonic," a word to describe forms that resemble the vagina. (Think: Georgia O'Keefe paintings.)

Changes to the speculum include:

  • Covering the metal in surgical-grade silicone that can be sterilized
  • Adding a third leaf to the "duck bill," which allows the cervix to be seen while minimizing the spreading sensation
  • Making it quieter

Their design is still in the works. In the meantime, most OB-GYNs have switched to disposable plastic speculums.

"I think the suggested improvements from Yona are positive, and plastic speculums are a good option," says Dr. Kelly Wright of Cedars-Sinai's Minimally Invasive Gynecologic Surgery Center. "We use clear plastic with the light integrated into the speculum. The plastic moves smoothly with lubrication and the clear sides allow us to see better during an exam."

They can still set your teeth on edge with an annoying clicking sound if not used properly, but Dr. Wright has a technique to avoid the sound and teaches it to residents who train with her.

A more comfortable pelvic exam

Dr. Wright says there's more to an improved pelvic exam than just the tool used.

"The skill of the provider is important," she says. "Pelvic exams are never comfortable, but they don't have to be painful."

A comfortable room and adequate coverings like sheets can go a long way to improving the experience. Having all the right tools well-organized and good nursing support will also make the exam as short as possible.

Less frequent exams

More good news: The speculum may always be needed, but women need fewer exams these days. Historically, a pap test and pelvic exam were recommended on an annual basis.

"Good data found this was too frequent," Dr. Wright says. "Now it's recommended women with normal results should be screened every 3 years in their 20s and every 3 to 5 years beyond that. We can make the speculum as comfortable as possible, but doing fewer speculum exams overall will also make patients happy and comfortable."